Application For Employment

    Position you are applying for    Desired hourly salary

    Date available for work

    Personal Information

    Last Name    First Name    Middle


    Cell Phone    Home Phone    Email

    Social Security Number    Date of Birth

    Are you a US Citizen? YesNo      Have you ever been convicted of a felony? YesNo

    If yes, please explain


    Are you employed currently YesNo   If yes, please complete the information below:

    Employer's Name

    Employer's Address

    How long have you been with this employer?    Present Salary

    Previous employment:


    School Name    Location    Years Attended

    School Name    Location    Years Attended

    What skills or additional training do you have that relate to the job for which you are applying?

    Will you consent to a pre- and/or post-employment drug screen as a condition of employment, if required? YesNo

    If no, please explain

    I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

    I understand that my employment may be subject to a 30 day probationary period.

    I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

    Digital Signature of Applicant    Date